The Cash Flow Fix Your Front Desk Hates (But Your Practice Needs)

A last-minute cancellation shouldn’t hijack three hours of your day. We dig into a simple shift—pre-collecting before you schedule—that lowers AR, slashes cancellations, and gives your front desk a calmer, cleaner workflow without awkward money talks at checkout.

By the end, you’ll have the words, the rules, and the check-ins to make pre-collections stick—and a team that sees it as clarity, not conflict. If this helped, follow the show, share it with a colleague who needs fewer no-shows, and leave a quick five-star review to help more practice owners find it.

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Transcript

The Pain Of Last-Minute Cancellations

Paul Etchison 1:22

Have you ever walked up to your front desk and said, Hey, I want to start pre-collecting to schedule here? And it usually comes right after a frustrating last-minute cancellation that like ruined three hours of your day and you're pissed off, right? You're just so pissed and you're like, that's it. That was the last straw. We are pre-collecting. No one will ever fail on me again. So you go up there and you tell your front desk that this is the new policy. And suddenly tension fills the room and you can feel the resistance. The eyes, they glaze over, they shift in their chairs uncomfortably, silence. And then someone coughs dramatically. And then the entire desk looks at you like you're asking them to do something like completely impossible. We're gonna start charging patients for breathing the air in the office or something like that. How dare you, doctor, make this the new policy? But let's face it, pre-collections is one of those things that every doctor knows they should be doing. But the moment that they try to enforce it, the entire team acts like you're asking them to charge admission at the front door. And here's the crazy part when pre-collections work, everything gets easier. The AR goes down, the cash flow improves, patients actually show up for their treatment. And the people who are afraid to tell the front desk no when they ask if they want to schedule, and then they end up canceling, they don't schedule anymore. So we have less cancellations there too. And we the best part is we have to chase considerably less balances. But the challenge, getting your team on board, that is the battle. So today we're gonna be breaking that down, not the theory, but the actual real world. How do you get this done in your office? I'm gonna show you. And by the end of this episode, you're gonna know exactly how to implement pre-collections without the drama. You're gonna know how to get your team bought in. And I'm gonna give you three tactical steps that make the enforcement smooth, predictable, and surprisingly painless. Now you are listening to the Dental Practice Heroes podcast, where we teach practice owners how to build a highly efficient and profitable practice, all while taking amazing care of their patients, taking amazing care of their teams, and taking tons of vacations because the practice makes money while you're not there. I am your host, Dr. Paul Etchison, author of two books on dental practice management, a dental coach, and the owner of a large five-doctor practice in the south suburbs of Chicago. If you want a practice that is team driven, doesn't feel like the golden handcuffs, and that makes a true difference in your community, you have come to the right place. All right, let's dive into it. So, why do pre-collections matter? I want to ask you, what is your collection policy at your office? Do you even have one? Or do you use the very common collection by emotion method? The collect, we collect how it feels. If the patient looks nice, we collect. If the patient looks angry or like they're having a bad day, well, we turn into a human exception machine and we send them a bill, which they never pay. We, as owners, we need to discuss these things because it is a very critical area of the practice that has huge downstream effects when we don't handle it properly. So let's start with the basics here. Pre-collections, it's not about being aggressive. It's not about being salesy, it is about preventing stress and extra work for everybody. So, what are some major benefits that we're gonna see? You know, the accounts receivable, it's gonna stabilize because we're no longer chasing patient balances that don't get paid. We keep more patients. Now, people say, how do you lose patience when you don't pre-collect? Because sometimes a patient has a balance and they don't know where it came from and they want to check their records because they think they paid what they were supposed to pay. But then they don't check their records, so they cancel their next appointment because they need to check their records before coming in. But again, they don't. And then it's been so long they're embarrassed that they haven't been back there and they just find another dentist. Yeah, that actually happens. All right, what else? We have fewer surprise balances. I'm saying surprise balances and quotes, the surprise balances that are only the surprise to the patient, even though we already discussed it, which will result in fewer awkward conversations at the front desk. We're gonna have fewer statements, we're gonna have fewer follow-ups, considerably less. You know, this is gonna solve a big problem of the front desk being overly busy because they're not gonna be constantly collecting money over and over again. They're gonna do it one time and they're gonna pre-collect. And this is the biggest benefit, which I think you really need to hit home with your team. They don't have to chase balances anymore. They don't have to audit the chart because the patient's unsure of where this balance came from. They don't have to look at the EOB again and make sure the calculation was correct. They no longer have to present the treatment again and go over what insurance is gonna cover. Because once the patient is done considering the purchase, it's over. They're ready to move forward. All right, what else? Fewer cancellations. Yeah, totally, because really almost nobody cancels on the doctor's side when they pre-collect. It's almost uncanny how I hate to say they never cancel on the doctor's side, but it's nearly never. When you pre-collect, you rarely get somebody cancel on your doctor's side. And the last thing, which we often overlook, is that it feels better as a patient. It feels better psychologically and emotionally, because one thing that I learned when I was an advertising major in undergrad is that consumers enjoy experiences better when they're paid in full before they experience them. So because they've already parted with the money, the only thing left to do, they don't have to consider a purchasing decision anymore. They don't have to weigh the pros and cons, whether they want it or not. They've already done that. And the only thing left to do is to enjoy the service. Now, we're a dental office. Are people really going to enjoy it? No, but they'll enjoy it more, right? That's what I'm trying to say. Now, I remember a while ago, I had this one client who had acquired an office with an absolutely atrocious AR. Like, seriously, the worst I had ever seen. I remember sitting at my desk and we're on a Zoom call together and we're going through, we're running reports in his practice management system, and we're trying to figure out, dude, like what is going on with this AR? It is out of control. I've never seen one so low. I didn't tell him that at the moment. But, you know, what do you think we found when we started digging? Well, a ton of old balances, like patient balances, where sometimes they sent a statement, sometimes they didn't. And they did the collection by emotion policy. They were just, you know, when I feel like it. And their patients and their team was really used to it. So they had a big problem. And that was the way they always did it. You know, send the bill, you know, let the claim close, send the bill. And half the time they weren't even sending the bill. So, like the doctor was just never getting paid. So, I mean, no harm to the patient, right? I mean, the patient doesn't mind. And I mean, no harm to the team. They're okay, they're still getting paid. But what about the owner doc? Yeah, that kind of sucks for the owner doc because you paid for all the expenses, you paid the team, you did the work, but you didn't get paid. Not cool, right? So we had to implement some new collection policies and wowzers, wouldn't you know the team did not like that one bit? So, why do teams resist pre-collections? So, before we get into that, I want to say this clearly like understand that if your team hasn't been enforcing this, if your team doesn't have good collection policies, that doesn't mean you're a bad leader. It doesn't mean you're soft, it doesn't mean you failed. It means you're human, you're running a business full of humans who are also dealing with money, which is the most emotionally loaded thing on the planet. So I will tell you from being a coach for the past six years, collection issues are the most common issues in dental practices. It is almost every office I work with has some extent of a collections issue. So please do not feel bad. Okay, you're not alone. All right, let's talk about the main reason that our teams resist pre-collecting. Well, the main reason is fear. They have a fear that it's a patient confrontation they don't want to have. They worry that asking for money makes them the bad guy. They have this belief that this policy is going to damage the relationship with the patients. And why do they feel so uneasy about it? It's because a lack of scripting, a lack of training, that leads to a lack of confidence on their part and they don't want to do it. And it just seems so foreign. Like, who collects before scheduling a service? Like, seriously, or a dental office. Nobody collects the payment before doing a service. Well, I mean, is that true? Let's think about a few other industries. Airlines, well, airlines, you don't bill after your flight. You don't pay the day of, you pay the day you book. What about hotels? Yeah, they usually put some kind of charge on the credit card and they have that credit card on file. Sometimes they you pay in full and sometimes you have to put a little deposit. That's pretty common. What about Uber and Lyft? Do they charge your card before they pick you up or do they charge you after? Well, I mean, they charge it before. It gets charged right away. If your credit card's not going through, that ride is not coming. What about daycares? Preschools, perhaps? Do they charge before the month or do they charge after the month? Hmm, another one. What about contractors or like people that are fixing up something in your home? I mean, you've got to put some deposit. Typically, you've got to pay either half or you're paying a third before the job is done. So there's another one. A veterinary? Yeah, veterinary, he doesn't even work with insurance. So they pre-collect to schedule often. If you're having a procedure done, you have to pay before you get that procedure done, before you even schedule it. What about concerts? How about somebody go to a concert and then based on how much you enjoyed yourself, you pay afterwards. If you want a ticket, you're gonna pay in full. What about a gym? Yeah, here's another one. So you got to pay for your gym membership before you use the gym. So think about this. It is not as foreign as your team may think. There are lots of industries that do that. And the fact of the matter is, there is no reason why we shouldn't be. So you've got to attack this mindset directly. You need to change this mindset in your teams. All right. How do you enforce pre-collections without drama? Because that's what we want. We just don't want the drama, right? I'm gonna give you three tactics here. Tactic number one, script it first. You gotta script it. The team has to be confident in order for this to work properly. They must believe it is the right thing for the patient, it's the right thing for the team, and they must believe that they can do it effortlessly without the patient being upset. And you, as the owner, have to give them the tools to do so. So we talked about it being the right thing for the patient. Why is it the right thing for the patient? Well, because only people who are truly committed take time on our schedule so we can help more people. We're not wasting time, we're not holding time for people that have no intentions of coming. It makes me so mad when we can't get a patient in who wants to be seen and then people cancel the same day. You know, it's also right for the patient because it helps us stay on time. And I'm gonna talk about that in a moment because I'm gonna give you a script to use to tell your team to use. So it allows us to stay on time because how much do we hate when the patient shows up right before the procedure and they have a million questions about their insurance, what the coverage is, and all this stuff. And it throws our whole day off. It's not fair to our team to run behind, it screws over everybody. Okay, so that's why it's good for them. Now you got to give them that confidence. So we're gonna give them the confidence in the script. So you can decide what you want this to be at your team, find something that works for you guys, find something that feels comfortable, but you wanna provide them with just a simple, friendly script of how to say it, maybe one sentence on why you guys do it. And then you got to give them some answers for what to say if the patient does resist and give some pushback because it does happen sometimes. It doesn't happen as much as you think it's going to, but it does. So it's very important that your team understands the confidence is like 80% of it. It's not the words, it's the confidence behind the words. So you want them to tell the patient what they're scheduling, the procedure they're gonna have done that day. And then they say, to reserve that time, we require that you place a down payment of 50% of your patient portion. Did you want to put down 50% or just take care of the whole thing today so we don't have to worry about it the day off? So easy peasy, it's confident. You say it. Now, why? Why do we do this? So if they say, Why do I have to pay to schedule it? We do this because we pride ourselves here in being an on-time practice. And in order for us to stay an on-time practice, we have to get all the financial things out of the way before the day of the appointment. Does that make sense? And then you might get some pushback. So, what do you do? If you get some pushback, you totally validate the patient. Hey, I totally understand your frustration, Mr. Jones. And then ask them, why are they frustrated about it? Can you tell me what exactly about it has you upset or what exactly about it has you frustrated? Because you want to know. Like it might be I've never had to do this before. It might be that I don't have the money today. I don't understand why I have to pay for something if I don't have it. I've always paid you guys. I mean, there's a million different objections. You want to list these with your team and give them good answers for all of them. But you got to understand: is it the money? Is it the principal? Is it that they've never done it? What is it? You know, and sometimes the patients don't even know. They just want something to be upset about. So this is where the policy is going to be successful. You've got to provide the scripts for the people at your practice. Now, I remember when we did this at my practice, I remember talking to my front desk team member, and she was very against the policy. Like she was very, I mean, I'm not talking like against it. There's no way, you know, the patients are gonna be pissed off. And you know, who's gonna get yelled at? You don't even care. Like, like we're the ones that are gonna get yelled at, not you. I don't like this, it's not gonna work, it's stupid. I don't understand why we have to do this, nobody else does this. And then I just like asked her. I said, you know, can we just try it? You think maybe we could just try it? I just want to try it. You know, sometimes you gotta get all puppy doggy and just say, can you just try it for me just for like a few weeks, please? I'm not asking a lot. I just want you to try it. Can we just try it and see how it goes? So that's what I did. And I said, I know a ton of offices doing this, people do it successfully. I know we are capable of doing it. I know you are capable of doing it. And about a week later, I followed up with her and asked her how it's been going. And she said, surprisingly, pretty good. None of the patients really cared. Well, wow, that's crazy. Can you believe it? Magic. All right, tactic number two, make a zero exception rule. Not forever. Okay, I want you to be able to make exceptions, but make a zero exception rule for one month, 30 days, because the thing is, exceptions ruin systems. Your team will forget about the nine times that they did it successfully, and they'll remember that one exception. And that one exception turns into 10 exceptions. And then the policy, before you know it, it is optional. Now, if the patient doesn't have their wallet, they can reschedule. We're not gonna punish them, but we're gonna hold them to the same expectation that we hold of every other patient. And in order for us to treat everyone fairly, we must enforce it with everyone. Think about this. And if we do make exceptions, and you do this with all your policies, when you make exceptions for patients, are they the good patients or are they like the pain in the ass patients? Who gets the exceptions? It's usually the pain in the ass patients. But then we don't make exceptions for our great patients who are always good to us and are always compliant with all our policies. No, it's not cool. We need to treat everybody the same, and the only way we can do it is by not making exceptions. So that's it. So I don't want your policy to fall flat. So I need you to not make exceptions. Now, I remember I coached the office and they did it. It was like they allowed the exceptions. You know, I would just play it by ear. Who knows? If you do something just for this one patient, it will very quickly morph into just for everyone. And then the front desk team member becomes the infamous accountability escape artist who gets away every single time. Don't let them do that. Stop them. You need to stop them. All right, tactic number three, check on it. Every single procedure, every single schedule, follow up every single week. Okay, I want you to check on these things every day, but I want you to follow up with your team every single week. Do not go silent. Create the policy, okay? And our policy at our office, I'll just share with you, it's any procedure requiring more than one hour of doctor time or anything that has a patient portion of more than$400. We are going to collect at least 50% to schedule the appointment. We want to collect 100% because when we collect 100%, that's one less transaction that we have to do. So try to collect 100%, but we're not doing anything less than 50%. I know some offices who do$100. I know some who do$150. And I really haven't seen a whole lot of difference. If you charge something, it typically works. The patients are committed and they do show up. So check on it. Check on the compliance. It's easy to see. Open up some charts, open up the account, and you want to see that credit on the account if you see something on your schedule. And this is the magic piece that most doctors miss. We need to communicate with our team while this is getting rolled out so we can make sure one, it's getting done, but two, that our team understands that we are here to support them through the learning phase. We are willing to help them where needed. So you're just gonna check in with your team 15 minutes. What felt hard about this? What objections came up? What scripts, what wording didn't work? What did somebody say where we didn't have a good answer? What do we need to tighten up? And don't forget to celebrate the wins. Celebrate those wins and normalize and validate that discomfort because it is uncomfortable. I really think that dentists, as owners, we underestimate how much just talking about it maintains the momentum while you're transitioning into this. It reminds me of this one coaching client I had named Dennis. We planned this whole policy out. Like we custom made it so it worked with his office, the scripting. We designed it. He was explaining it to his team in like two weeks from our phone call. And I remember I set a reminder to follow up with him that day. I want to know how the meeting went. So I texted him, I said, Hey, how did it go? And he said, surprisingly awesome. The team was all on board. It was great. And I remember just being really excited for him. So, like, I was like, dude, we got it. We're making progress. This is gonna make a huge difference in his office. So two weeks later, we had our next coaching call, and I got on Zoom with him, checked in about how life was going, like the small talk stuff. And I remember I just sat back, I took a sip of my coffee, excited to hear about the good news about the pre-collection policy. So I asked him, how's it been going with pre-collecting? And his answer, oh, I actually don't know. Let me pull up some charts and let's check on it. You don't know? What do you mean you don't know? So we pulled up some charts and one after another, looking for the credit on the account that they was pre-collected. Nope, nope, nope, nope again, nope. And I asked, why aren't they doing it? And he said, again, I actually don't know. We haven't talked about it since the meeting. So you see the problem here. So the next day, he brought it up with his front desk and he committed to me that he would do an end-of-day audit and he would address every issue right when it showed up, and that he would check in with his team every week as a group to see how they were doing. But he promised me he would audit every day. And this is the accountability we do. When you're coaching with us, we make sure you get it done. And what do you think happened? The policy went through. The policy stuck. It was good. Now you might be thinking, well, he had to check on it every single day. I don't have time to. Do that. He didn't have to check on it every single day forever. He only had to do it for like a week. I mean, this is the consistency. We needed to not set it and forget it. We need to stay on top of these things, communicate about it. So here are your tactical takeaways for today's episode. I want you to understand so much of this is mindset. The team needs to understand why it's good for the patients and why it's good for the team. And script confidence. That's what creates the policy compliance, the confidence in the scripts. And then remember, exceptions destroy systems. You need to be strict in the short term so that you can have that long-term ease. So make no exceptions and make sure you review this with your team. You got to support them. That's how you build momentum. If you are silent about it, you will kill your system. And your team, as well as you need to remember that patients are so much less resistant to pre-collections than your team or you think. And it's just the fear, the front desk fear, that is the real obstacle. It is not the patient behavior. The real obstacle of getting this going is the fear of your front desk. It's all mindset. So pre-collections, it is not about money. It is about clarity. The patients appreciate knowing exactly what to expect. We give them exactly what they expect. And your team is going to appreciate fewer billing headaches, fewer chasing of balances. And you get to have a practice that's calmer and more predictable and easier to run. So enforce it with confidence, enforce it with consistency, and have that short-term focus. And then the system will eventually become effortless. And if you want help building your financial and front end systems at your office, training your team, or enforcing these policies without conflict, sign up for a free strategy call with me at dentalpracticeheroes.com slash strategy, and we will help you put these systems in place as well as create a practice that runs without you so you can live an amazing life of leisure and of peace. Because we know how to make these things work in real dental practices. We are real dentists with real dental teams, and we will get your team to do it happily. Thank you so much for listening today. And if you like what you hear, please go on Apple Podcasts and give us a five star review. I would so appreciate it. And it helps more people hear the podcast. Thank you so much for listening. We'll talk to you next time.